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Medical Financial Assistance Policy

Statement of Policy

In keeping with their tax-exempt mission and community orientation, Bronson Methodist Hospital, Bronson LakeView Hospital and Bronson Battle Creek Hospital (collectively, “the Hospitals”) each acknowledge that all individuals are not equally capable of paying for healthcare services, either by themselves or through a third party insurance carrier. The Hospitals each recognize their responsibility to offer care for persons in need, and therefore the Hospitals each provide and promote access to emergency or medically necessary services without regard to ability to pay.

This Medical Financial Assistance Policy (“Policy”) has been developed to ensure that financial assistance for emergency or medically necessary services is provided to eligible individuals. Regardless of eligibility determination, confidentiality of the information submitted and individual dignity will be maintained for all that seek financial assistance.

Procedure

Patients who can demonstrate that the payment of their hospital bill would be an unbearable hardship may apply for medical financial assistance pursuant to this Policy. This applies to all services that are billed under the Federal Tax I.D. numbers for the Hospitals. Referrals for medical financial assistance may originate from any member of the medical staff, Patient Relations, Pastoral Care, Medical Social Work, Employee in Crisis Committee or other employees of the Hospitals.

Financial assistance may be pre-authorized for hardship cases with the approval of the Director of Patient Accounting.

A special exception can be made for any patient that is over the allowed income level but has catastrophic medical expenses over $10,000 from the Hospitals. The catastrophic approval applies only to the patient; it does not apply to family members living in the same household.

The amount of financial assistance (total or partial) will be determined by the following process:

The patient must be screened for any other financial assistance (Medicare, Medicaid, Michigan Crippled Children, etc.) and determined ineligible.

All other patients first will be scored through Lexis Nexis to determine if they are preliminarily eligible for financial assistance. If Lexis Nexis cannot score the account, the patient must complete an Application for Eligibility Determination (“the Application”).

The patient’s net household income must not exceed 300% of the poverty guidelines as provided by the Department of Health & Human Services for Region V.

Health insurance premiums, out of pocket expense for prescription drugs, child support paid to the Friend of the Court or alimony payments will be deducted from the monthly income. Receipts or check stubs are required to prove the amount to be deducted.

Patients that meet the Federal Poverty Income Guidelines will be presumed to be eligible for medical financial assistance.

Patients that are treated for services that are donated to the community through special programs like Blue Ribbon Days and Pink Saturdays are presumed to be eligible for medical financial assistance

Patients that are homeless are presumed to be eligible for medical financial assistance.

The Manager of Patient Financial Services will review the Application. Additional information to confirm income or assets may be requested before the Application is approved or denied.

In the event that assets or a payment become available, the Hospitals reserve the right to reverse the original adjustment.

Net household income up to 225% of FPL is entitled to an 80% reduction

Net household income up to 250% of FPL is entitled to a 60% reduction

Net household income up to 275% of FPL is entitled to a 40% reduction

Net household income up to 300% of FPL is entitled to a 20% reduction

The Hospitals’ charge for patients who are eligible for the medical financial assistance policy shall be limited to no more than the average rate of the three lowest commercial rates. (For example, – if the Hospitals gross charges were $10,000, and the average of the three lowest commercial rates is 60%, then the charge to the patient will be $6,000. If the patient qualifies for the 20% reduction, it would be a 20% reduction on the $6,000)

Final approval for financial assistance adjustments is the responsibility of the Manager of Billing and Collections, or their designee, for approvals up to $20,000. Any request exceeding $20,000 requires the approval of the Director of Patient Accounting or their designee. Requests over $50,000 require approval from the VP of Finance or their designee.

A final determination will be made on eligibility within thirty (30) working days after completion of the application (en Español). The patient will be notified of the final determination in writing. The eligible period for the discount will apply to any accounts that are open at time of approval regardless of the date of service. The approval will cover future visits for a period of 6 months from the date the application is signed. The patient cannot re-apply for assistance for dates of services that were previously approved for partial financial assistance.

This Policy shall not provide payment to physicians or other providers for services they render to patients receiving financial assistance from the Hospitals.

Annual Medical Financial Assistance Allowance

The budget for medical financial assistance shall be determined annually.